The Ankle

The AnkleThe Ankle

Anatomy of the AnkleAnatomy of the Ankle

TalusTalus TibiaTibia FibulaFibula

All of these bones All of these bones make-up the ankle make-up the ankle

mortismortis

Motions of the AnkleMotions of the Ankle

Plantar FlexionPlantar Flexion Dorsi-flexionDorsi-flexion Inversion Inversion EversionEversion

Ligaments of the AnkleLigaments of the Ankle

LateralLateral Anterior talofibular ligamentAnterior talofibular ligament Calcaneofibular ligamentCalcaneofibular ligament Posterior talofibular ligamentPosterior talofibular ligament

MedialMedial Deltoid ligament-strongest of the ankle Deltoid ligament-strongest of the ankle

Muscles of the AnkleMuscles of the Ankle

Dorsi-flexors (Anterior Leg)Dorsi-flexors (Anterior Leg) Tibialis-anteriorTibialis-anterior Extensor Hallucis LongusExtensor Hallucis Longus Extensor Digitorum LongusExtensor Digitorum Longus Peroneus TertiusPeroneus Tertius

Muscles of the AnkleMuscles of the Ankle

Plantar-Flexors (posterior leg)Plantar-Flexors (posterior leg) GastrocnemiusGastrocnemius SoleusSoleus Flexor Hallucis Longus*Flexor Hallucis Longus* Flexor Digitorum Longus*Flexor Digitorum Longus* Tibialis Posterior*Tibialis Posterior*

*These also act as invertors*These also act as invertors

Muscles of the AnkleMuscles of the Ankle

Evertors (lateral Evertors (lateral leg)leg) Peroneus LongusPeroneus Longus Peroneus BrevisPeroneus Brevis

Lateral Ankle SprainsLateral Ankle SprainsClassificationsClassifications

Mild (1Mild (1stst)) Out 3-7 days, involves the ATF and possibly the Out 3-7 days, involves the ATF and possibly the

CF:Localized tenderness over ligament, pain CF:Localized tenderness over ligament, pain when ligament is stretched, no loss of function when ligament is stretched, no loss of function or instability, mild swelling, can weight bear or instability, mild swelling, can weight bear and walk w/o much pain. and walk w/o much pain.

Moderate (2Moderate (2ndnd)) Out 10-21 days, involves the ATF,CF, PTF some Out 10-21 days, involves the ATF,CF, PTF some

tearing but not complete (ATF could be tearing but not complete (ATF could be complete) Tenderness over all the ligaments, complete) Tenderness over all the ligaments, swelling, pain with motion, non weight bearingswelling, pain with motion, non weight bearing

Inversion Mechanism of Inversion Mechanism of InjuryInjury

Mild Ankle SprainMild Ankle Sprain

Moderate Ankle SprainModerate Ankle Sprain

Lateral Ankle SprainsLateral Ankle SprainsClassificationsClassifications

SevereSevere Out 6-8 weeks, usually requires surgery Out 6-8 weeks, usually requires surgery

ATF and Anterior Tibiofibular ligament ATF and Anterior Tibiofibular ligament ruptured. Severe pain and spasm, ruptured. Severe pain and spasm, complete loss of functioncomplete loss of function

Potts FracturePotts Fracture

Fracture of the FibulaFracture of the Fibula

Medial Ankle SprainsMedial Ankle Sprains

Unusual but does Unusual but does occur to the deltoid occur to the deltoid ligament.ligament.

Other TidbitsOther Tidbits

The anterior Tibiofibular ligament is The anterior Tibiofibular ligament is also known as the syndesmosis also known as the syndesmosis ligament.ligament.

An injury like this is typically called a An injury like this is typically called a high ankle sprain.high ankle sprain.

Return to play criteria varies athlete to Return to play criteria varies athlete to athleteathlete

HOPS for the AnkleHOPS for the Ankle

HistoryHistory What happened What happened

(recreate (recreate mechanism)mechanism)

Have you hurt it Have you hurt it beforebefore

Did you hear any Did you hear any soundssounds

Have you had Have you had previous surgeryprevious surgery

HOPS for the AnkleHOPS for the Ankle

ObservationObservation SwellingSwelling DiscolorationDiscoloration How did they walk inHow did they walk in ScarsScars DeformityDeformity

HOPS for the AnkleHOPS for the Ankle

PalpationPalpation Where does it hurtWhere does it hurt What does pain feel likeWhat does pain feel like Palpate all ligamentsPalpate all ligaments Palpate the bony Palpate the bony

structuresstructures Look for point Look for point

tendernesstenderness Go through AROM and Go through AROM and

PROMPROM Determine structures Determine structures

injured injured

HOPS for the AnkleHOPS for the Ankle

Stress or Special TestsStress or Special Tests Looking for functionality of the joint Looking for functionality of the joint

and disruption of structure and and disruption of structure and functionfunction Talar TiltTalar Tilt Anterior DrawerAnterior Drawer Eversion TestEversion Test

Anterior DrawerAnterior Drawer